17- year-old girl needs liver transplant, CIGNA denies
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Life Denied: Nurses, Family of Sick Teen March on Health Insurance Company Thursday - 17- year-old girl needs liver transplant, CIGNA denies...
The family and the nurses are urgently appealing to... Read More

I can't believe some of the insensitivity here. A CHILD DIED. C'mon people!!!

I worked for a very prominent insurance company and quit because of stuff like this. I had to tell a woman that her liver transplant was denied because it was "not medically necessary". I saw all of her medical documentation and everything. She had LIVER CANCER. IT WAS MEDICALLY NECESSARY.

Insurance companies are big time scammers and I am SO glad I don't work for one anymore.

I can't believe you are all educated nurses!.. OK, do you have any idea how many people there are in the USA awaiting organ transplants?.. Do you know how long the average wait for a matching liver is?.. Considering the girl went into failure the beginning of December and the decision was made around the 10th or so that she needed a transplant.. I find it truely amazing that they would find a matching donor the following day! Lets also look at the fact that she had leukemia that would have probably required chemo in the future ( as many of these patients can go in and out of remission).. She was in a vegatative state, which tells me she had multi organ failure...And you are telling me she was a good candidate?.. Come on...It is unfortunate but chances are that this patient was going to die whether or not CIGNA approved the transplant or not.. Transplants are not like blood transfusions.. they take alot of time to arrange and follow thru with.. Please educate yourself. Ignorance is no excuse!. And stop blaming the insurance companys for all your healthcare woe's!

And picture this.. Your doctor walks in your hospital room and says to you " I'm sorry, but I cannot operate because you can't pay me" How cruel is that?.. But that is really what is going on here! How can hospitals and doctors tell patients we can't help you because you can't pay.. How is that any different than the insurance co telling you that?.. And don't tell me they should pay because you are paying them money for coverage.. You are also paying taxes, which pay for the uninsured!( Which of course you cannot take advantage of because you are insured!)

So step away from your pulpit, and open your eyes! I am not without feelings, but if I am going to donate my liver to someone after I die, I want it to go to someone who is going to use it for longer than 5 minutes.. And that 65% survival/.. Exactly how long and what quality of live did that include? Do your homework.

I can't believe you are all educated nurses!.. OK, do you have any idea how many people there are in the USA awaiting organ transplants?.. Do you know how long the average wait for a matching liver is?.. Considering the girl went into failure the beginning of December and the decision was made around the 10th or so that she needed a transplant.. I find it truely amazing that they would find a matching donor the following day! Lets also look at the fact that she had leukemia that would have probably required chemo in the future ( as many of these patients can go in and out of remission).. She was in a vegatative state, which tells me she had multi organ failure...And you are telling me she was a good candidate?.. Come on...It is unfortunate but chances are that this patient was going to die whether or not CIGNA approved the transplant or not.. Transplants are not like blood transfusions.. they take alot of time to arrange and follow thru with.. Please educate yourself. Ignorance is no excuse!.

Please see Spacenurse's replies to these questions in previous posts. It appears that the patient was in a condition to transplant when an organ was available.

Quote from jeolsz

And stop blaming the insurance companys for all your healthcare woe's!

And picture this.. Your doctor walks in your hospital room and says to you " I'm sorry, but I cannot operate because you can't pay me" How cruel is that?.. But that is really what is going on here! How can hospitals and doctors tell patients we can't help you because you can't pay.. How is that any different than the insurance co telling you that?.. And don't tell me they should pay because you are paying them money for coverage.. You are also paying taxes, which pay for the uninsured!( Which of course you cannot take advantage of because you are insured!)

So step away from your pulpit, and open your eyes! I am not without feelings, but if I am going to donate my liver to someone after I die, I want it to go to someone who is going to use it for longer than 5 minutes.. And that 65% survival/.. Exactly how long and what quality of live did that include? Do your homework.

Yes, they should pay because I'm not just paying them money for coverage, I'm paying A LOT of money for coverage that I am not getting because the insurance company keeps telling me that I do not qualify. Or they stonewall the docs and refuse to pay or withhold pay for months, for no good reason. Our hospital recently dropped a provider because they did exactly that -- they never paid the docs.

My insurance company actually withheld reimbursement to my doc because for months, they argued about my son's birthdate. My doc did not get reimbursed for over a year for a simple office visit! The office called and even I wound up calling the insurance company at least four times to get the problem resolved but each time, everyone had the correct information, yet the money sat at the insurance company, costing my doc's office more money to try to obtain.

This happened with a child who's been sick enough to see a doc exactly 10 times in his life and he's now 18. I cannot imagine what people whose children are really sick go through.

As for the "doing your homework" part of your post, if the girl qualified to get a liver, her case had to jump through numerous hoops in order to qualify. They don't just recommend transplants for everyone, believe it or not. She was eligible and the family has a case. Time was of the essence in her case, and every standard of care calls for timely treatment.

What good is an appendectomy after the patient dies? Same principle applies here.

The insurance company needs to bear some of the responsibility for this girl not getting the timely treatment that was recommended by her docs and cleared by the transplant committee.

As far as "homework" is concerned, I believe that had she had the transplant, the insurance company realized how long her life would be, all the while having to take expensive medications and other treatments for years, and that is why Cigna initially denied her.

Insurance companies are in it for the money. Period. The corporation does not care about individuals. The corporation cares about the bottom line. Yes, I agree that a lot of the physicians are in it for the money too. I've seen the Audis and Jaguars driven by a lot of them. But I also know that many of the executives of hospitals and insurance companies have two homes and several high-end cars. I work for a for-profit company, and I don't for a minute believe that they care about the individual patients. I care about my patients, but the powers that be are motivated by profits.

I'm really sorry that the girl died. However, I still wonder about how good of a candidate she really was. If she was cured of the leukemia and had no other co-morbidities, and no other organ failure, then I suppose she might have been a good candidate. If that were the case, then CIGNA should have covered it and not delayed treatment. Insurance companies DO delay treatment on purpose. If they wait long enough, maybe the patient will die, and the point will be moot. And insurance companies don't like to pay to prevent illness. It seems like a no-brainer to me that they would save more precious dollars by paying for preventative measures, but apparently some bean counter has figured that it doesn't make for good profits to help keep people healthy.

I wish I could have been a fly on the wall as this situation was going down. When I worked for a large academic facility prior to becoming a nurse, I saw firsthand how physicians could sometimes be pressed to pursue futile treatments. With the talk about a vegetative state, I just can't help but wonder if that were not the case here.

The information currently available probably raises more questions than answers.

Also, after working at an insurance company, I have seen some horrid things. Claims get denied for NO reason and a member will not find out about it until their doc tells them about it, and it may be too late to have the claim reprocessed etc.

I also used to bump claims up to be reprocessed if a member had been waiting for than 4 weeks because I was told they would "just have to wait". How nice!

I wish I could have been a fly on the wall as this situation was going down. When I worked for a large academic facility prior to becoming a nurse, I saw firsthand how physicians could sometimes be pressed to pursue futile treatments. With the talk about a vegetative state, I just can't help but wonder if that were not the case here.

The information currently available probably raises more questions than answers.

This article is the first I have read that addresses some of these questions:

Nataline was diagnosed with leukemia at 14 and received a bone marrow transplant from her brother the day before Thanksgiving. She later developed a complication that caused her liver to fail. She was in a vegetative state for some time, her mother Hilda said....

In a Dec. 11 letter to Cigna, four doctors had appealed to the insurer to reconsider. They said patients in similar situations who undergo transplants have a six-month survival rate of about 65 percent....

The case raised the question among at least one medical expert over whether a liver transplant is a viable option for a leukemia patient because of the immune-system-suppressing medication such patients must take to prevent organ rejection.

Such medication, while preserving the transplanted liver, could make the cancer worse.

Transplantation is not an option for leukemia patients because the immunosuppressant drugs "tend to increase the risk and growth of any tumors," said Dr. Stuart Knechtle, who heads the liver transplant program at the University of Wisconsin at Madison and was not commenting specifically on Nataline's case.

None of us knows the details of coverage in this family's policy. Perhaps CIGNA legitimately denied coverage for the transplant due to stated limitations of the policy, perhaps not. But anyone who thinks that government-sponsored insurance is without limits is mis-informed.

The following thread highlights Medicare's denial of an effective and much less costly treatment.

The medicare issue will ultimately be reversed because medicare is under the control of the people through the political process. Insurance companies are answerable only to shareholders.

PNHP addresses this issue in their FAQ:

There is a myth that, with national health insurance, the government will be making the medical decisions. But in a publicly-financed, universal health care system medical decisions are left to the patient and doctor, as they should be. This is true even in the countries like the UK and Spain that have socialized medicine.
In a public system the public has a say in how it’s run. Cost containment measures are publicly managed at the state level by an elected and appointed body that represents the people of that state. This body decides on the benefit package, negotiates doctor fees and hospital budgets. It also is responsible for health planning and the distribution of expensive technology.
The benefit package people will receive will not be decided upon by the legislature, but by the appointed body that represents all state residents in consultation with medical experts in all fields of medicine.

Even the expert who is saying a 65 per cent survival rate was giving her a better than even chance for survival. She should have been given the liver given her relatively young age.

Of the 1,107 patients under age 18 who received liver transplants nationally from Jan. 1, 2004 to June 30, 2006, nearly 92% survived at least one year. But most were not as ill as Nataline
...
Dr. Goran Klintmalm, chief of the Baylor Regional Transplant Institute in Dallas, said the operation that UCLA wanted to perform was a "very high-risk transplant" and "generally speaking, it is on the margins."

But Klintmalm said he would consider performing the same operation on a 17-year-old and believes the UCLA doctors are among the best in the world.

"The UCLA team is not a cowboy team," he said. "It's a team where they have some of the soundest minds in the industry who deliver judgment on appropriateness virtually every day."

the medicare issue will ultimately be reversed because medicare is under the control of the people through the political process. insurance companies are answerable only to shareholders and the bottom line.

viking,

you state that the medicare issue will ultimately be reversed. perhaps it will, perhaps not. but it hasn't been reversed yet. as much as you like to point out the failings of the private insurance system, cigna's decision was reversed within a matter of days. that doesn't happen when a government bureaucracy is involved, as evidenced by the fact that medicare hasn't yet reversed its decision, and maybe never will.

even the expert who is saying a 65 per cent survival rate was giving her a better than even chance for survival. she should have been given the liver given her relatively young age.

he was giving her a 65% chance of surviving the next 6 months. that is not long-term survival, nor does it indicate any quality of life. the transplant expert from wisconsin indicated that, "the procedure would be futile." as sad as it is, we need to consider the potential benefit when allocating precious healthcare resources, which are limited, whether we like to admit that or not. no system, private or government, can provide unlimited healthcare funding to everyone in every circumstance. there is rationing in any system. that includes rare organs, as well as money. my heart goes out to this family. but it truly sounds like the transplant simply would have prolonged this precious girl's death, not given her any real hope of life and health. we decry prolonging death in micro-preemies and the frail elderly. it is understandable that it is difficult to accept the same for a young woman, but that does not justify the use of limited resources (organs or money) in a case with no hope of meaningful recovery.